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NPI Code Detail

MEDICARE: KIM DUONG

MEDICARE: KIM DUONG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPH233607MA

General Provider Information

NPI Number : 1356946941
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM DUONG
Provider Business Mailing Address
First Line : 8 ROSELAND ST
Second Line :
City : BOSTON
State : MA
Zip : 02124-2407
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2235 DORCHESTER AVE
Second Line :
City : BOSTON
State : MA
Zip : 02124-5623
Country : US
Telephone Number : 617-296-1025
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2020
Last Update Date : 12/01/2020

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Directions to “ KIM DUONG ” Practice Location

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